Time: “America’s Medicated Army”

This is another post in the series about an Army near the breaking point. I strongly recommend reading the full article, from which the following is just a brief excerpt. This is one of the best researched and written articles I have seen from a US weekly in a long time. For more information see the reference page, which links to the major reports and articles about the problems facing our Army.

For the first time in history, a sizable and growing number of U.S. combat troops are taking daily doses of antidepressants to calm nerves strained by repeated and lengthy tours in Iraq and Afghanistan. The medicines are intended not only to help troops keep their cool but also to enable the already strapped Army to preserve its most precious resource: soldiers on the front lines. Data contained in the Army’s fifth Mental Health Advisory Team report indicate that, according to an anonymous survey of U.S. troops taken last fall, about 12% of combat troops in Iraq and 17% of those in Afghanistan are taking prescription antidepressants or sleeping pills to help them cope. Escalating violence in Afghanistan and the more isolated mission have driven troops to rely more on medication there than in Iraq, military officials say.

At a Pentagon that keeps statistics on just about everything, there is no central clearinghouse for this kind of data, and the Army hasn’t consistently asked about prescription-drug use, which makes it difficult to track. Given the traditional stigma associated with soldiers seeking mental help, the survey, released in March, probably underestimates antidepressant use. But if the Army numbers reflect those of other services – the Army has by far the most troops deployed to the war zones – about 20,000 troops in Afghanistan and Iraq were on such medications last fall. The Army estimates that authorized drug use splits roughly fifty-fifty between troops taking antidepressants – largely the class of drugs that includes Prozac and Zoloft – and those taking prescription sleeping pills like Ambien.

… Using drugs to cope with battlefield traumas is not discussed much outside the Army, but inside the service it has been the subject of debate for years. “No magic pill can erase the image of a best friend’s shattered body or assuage the guilt from having traded duty with him that day,” says Combat Stress Injury, a 2006 medical book edited by Charles Figley and William Nash that details how troops can be helped by such drugs. “Medication can, however, alleviate some debilitating and nearly intolerable symptoms of combat and operational stress injuries” and “help restore personnel to full functioning capacity.”

… And professionals have their doubts. “Are we trying to bandage up what is essentially an insufficient fighting force?” asks Dr. Frank Ochberg, a veteran psychiatrist and founding board member of the International Society for Traumatic Stress Studies.

Such questions have assumed greater urgency as more is revealed about the side effects of some mental-health medications.

… Repeated deployments to the war zones also contribute to the onset of mental-health problems. Nearly 30% of troops on their third deployment suffer from serious mental-health problems, a top Army psychiatrist told Congress in March. The doctor, Colonel Charles Hoge, added that recent research has shown the current 12 months between combat tours “is insufficient time” for soldiers “to reset” and recover from the stress of a combat tour before heading back to war.

… And yet the battlefield seems an imperfect environment for widespread prescription of these medicines. … LeJeune says the medications – combined with the war’s other stressors – created unfit soldiers. “There were more than a few convoys going out in a total daze.”

7 thoughts on “Time: “America’s Medicated Army””

This is – I am afraid – nothing new: A lot of Vietnam vets used drugs to cope with the war in Indochina and before that it was normal that soldiers drank alchohol to cope with the stress of war. It has been like that for centuries. It is certainly a bad sign, but pretty normal in wartime I am afraid.

I have heard a story – most likely true – that Taleban fighters take heroin in Afghanistan. A Danish colonel took it as a sign that they were losing. For me it only shows that Taleban fighters also are just human beings and scared in combat like everybody else. But it doesn’t stop them killing NATO-soldiers.
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.Fabius Maximus replies: Another great comment. You should start a blog!

if 12% of combat troops in Iraq… are taking prescription antidepressants or sleeping pills to help them cope… it means 88% are NOT. Why wasn’t the article about that??

it would be more helpful if we knew what percentage is anti-depressants and what percentage is sleeping medications. If I had to hazard an [educated] guess, it would be that the much larger percentage would be sleep meds: since many of the troops in theater take sleep medications because of the tempo of operations (e.g., trying to sleep during day time hours, having to sleep immediately after extreme adrenalin exposure from patrol/combat operations… and the often miserable sleeping arrangements.

I am not trying to minimize the effects that deployments have on soldiers… just not sure one more “the military is broken” meme is working…
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.Fabius Maximus replies: At what fraction taking anti-depressants would you become concerned? The point of such articles is to warn us of a developing problem, not wait until it has become serious and say “whoops, too bad.”

“it would be more helpful if we knew what percentage is anti-depressants and what percentage is sleeping medications.”

This information is, of course, in the article:

“The Army estimates that authorized drug use splits roughly fifty-fifty between troops taking antidepressants — largely the class of drugs that includes Prozac and Zoloft — and those taking prescription sleeping pills like Ambien.”

I was in western Afghanistan in 2004-2005. It was common to find locations of old legal and illegal check points by the large number of discarded syringes scatted about. These were not Taliban check points, but rather Afghani semi legal militia check points.

It is great fun to come upon these manned check points at night and wonder what state the locals are in as you approach.
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.Fabius Maximus replies: Thank you for this observation! It is always valuable to have first person information about these things.

FM: I’m not concerned about the current level of those on anti-depressants nor sleep meds in theater any more than I am concerned about them in general society. I’m not sure why the prescription and use of legitimate medications is per se of such great concern (I’m not being flip.. I just don’t share the “oh look, we have a problem” philosophy. Sorry.)

The troubling aspect is the lack of adequate follow up for those on such medications; however, THAT is the problem that requires remedy, not a ban on dispensation of medications. Medications for neuro/psychological conditions are as legitimate as medications taken for kidney ailments, heart conditions, blood pressure, etc. — some of which are appropriate for use when deployed and others that are not.

I believe the “OH NO! he’s on medications” reaction contributes to (or is a part of) the ongoing stigma that deters some from getting help. Taking medications does not in and of itself signify a problem nor does it mean that those taking medications are unable to perform their jobs or are some sort of hazard to themselves or to others. SAFEGUARDING that they are not [dangerous] is the imperative. I am, for the time being, more concerned with those who do not seek help (medicinal or therapeutic) at all and those that self-medicate (during and after deployment) with OTC medications and whatever else is available via the internet and other sources.

I misread that statement initially [in the article] on the split between anti-depressants & sleep meds… but remain surprised at the split. Be that as it may, it appears the military is damned if they do and damned if they don’t. As I recall, not so long ago, the complaint was that so many soldiers suffered mental health issues and weren’t getting (whether it was not seeking or not receiving) appropriate care; however, now that some percentage have sought and are receiving treatment, that has become the new “problem”. I don’t believe that “don’t dispense or don’t deploy” is a legitimate policy that can be substantiated except by those that believe no deployment — ever — should be the policy. The reality is that these are the conditions (counterinsurgency) under which our military likely will be fighting in the future [somewhere, anywhere] when they are called upon to do so and how to safely and effectively care for and treat soldiers in the battlefield — for physical as well as psychological conditions — must be attended.

The challenge (and all of our responsibility) is to be sure that the opportunity (in and out of war zones) for appropriate and effective treatment is available for our military (in and out of war zones) and for veterans AND TO DEMAND THAT SUCH SERVICES ARE APPROPRIATELY FUNDED BY CONGRESS (see, for example, the 10.6% CUT to Tricare (military medical insurance) payments to physicians slated for July 1.)
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.Fabius Maximus replies: I believe the author was clear about the potential problems. (1) Lack of care in prescription, with medicine being used to extend duty time. (2) Lack of follow-up care. Both of these relate to medical care in violation of standard protocols.

WW2 fighter pilots used to use Benzedrine (ref: Clousterman), there was use in Korea and Vietnam (etc, etc), but hadn’t this been debunked? In the sense that by the time the person needs regular use of a drug to continue to fight they are well over the performance curve and are a risk to themself and/or their comrades (any insights or information by more knowledgeable people in this area would be welcomed)? Isn’t this an indication that they need to be off operations for at least a few days or weeks? If they are doing this on a regular basis does this imply they have no reserves to be able to give people time out and rotate?

No matter how well prepared or trained they are, you can only push people so far. A follow up on this by FM and knowledgeable others at a later date would be invaluable.
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.Fabius Maximus replies: Yes, I too would like to learn more about this. As our psychoactive drugs become more powerful, the temptation to use them on our soldiers were grow — modifying their aggressiveness, endurance, and willingness to take orders.